Water, sanitation and menstruation: lessons from the East and Southern Africa Menstrual Hygiene Management Symposium

What does Menstrual Hygiene Management (MHM) mean? According to UNICEF and WHO (2014), it’s defined as women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management material.

The definition recognises the need for MHM products, access to water and soap for cleaning up, a private place to change sanitary pads and lastly, disposal facilities.

It may seem obvious to everyone that water, sanitation and hygiene (WASH) are at the heart of MHM, but my recent participation in the first East and Southern Africa MHM Symposium in Johannesburg made me realise that this is not the case. While our implementation of MHM programmes aims to be holistic and acknowledge issues such as affordable menstrual products and effective policies, menstruating girls and women will agree with me that decent menstrual hygiene management requires access to clean water, safe, private toilets and disposal facilities.

Some may argue that the absence of water and toilets does not necessarily mean you cannot manage your period, especially in emergency settings like refugee/migrant situations. However these are unique scenarios and should not detract from our efforts to make safe, private toilets a reality for everyone everywhere.

The MHM Symposium

The United Nations Population Fund and the Department of Women in the Republic of South Africa hosted the first East and Southern Africa Regional Symposium on Improving Menstrual Health Management for Adolescent Girls and Women on 28-29 May at Hilton Hotel, Johannesburg. The Symposium brought together global, regional and national government officials, academics, civil society, United Nation Agencies, the private sector, youth-led organisations and social entrepreneurs (such as companies that manufacture MHM products).

It is encouraging to see how many international, regional and national organisations and governments are showing interest in MHM, not just through participation in the Symposium but also through their sharing of MHM guidelines and policies, and their adoption of different initiatives across East and Southern Africa region.

Side session: WASH and MHM waste disposal

WaterAid Southern Africa regional office together with UNICEF and the Water Supply and Sanitation Collaborative Council convened a WASH and waste management session during the Symposium. Attendance was disappointing compared to sessions on education, financing and product availability, which were quite popular. However, it was still useful to discuss findings from our areas of expertise.

UNICEF shared their extensive experience working in school settings, whereas WaterAid drew on their knowledge of healthcare facilities and menstrual waste disposal, as well as learnings from an MHM working group based in India.

Our guest speakers included Vivian Onano, WaterAid Global Youth Ambassador, who shared some inspiring cases of MHM interventions in West Africa. Anthony Odili – University of KwaZulu Natal gave an insightful presentation on 'Understanding access to sanitation facilities and menstrual waste disposal practices'. Furthermore, Julie Hennegan from Johns Hopkins University presented on 'Menstrual hygiene, WASH and waste disposal: what can we learn from nationally representative data from Ethiopia and Kenya?'

Key issues emerging from the WASH and waste disposal session

WASH must be part of a holistic MHM approach and must take into account and address the challenges specific to varying contexts/ localities.

Supportive facilities, especially water and sanitation waste management systems, must be provided and must be sustainable, affordable, safe and of good quality.

National guidelines and quality assurance around water and sanitation and waste disposal menstrual products need to consistently implemented. This requires tackling a wide range of taboos and social norms that determine which products girls and women choose and how they use them.

There must be more focus on environmentally-friendly, culturally-appropriate, safe and efficient disposal systems, and intensify research on solutions in the region.

There is a need for greater understanding of how women are managing menstruation in the context of increasing water scarcity.

Recommendations for improved MHM in the region

All stakeholders should prioritise access to clean water, decent sanitation and good hygiene practice as key for the effective management of menstruation.

WASH organisations like WaterAid, WSSCC etc. have a significant role to play in raising awareness on the importance of access to WASH for MHM.

MHM-specific indicators are needed to best capture menstrual needs and progress.

We need to foster political support and social acceptance through well-organised Information, Education and Communication (IEC) Campaigns about innovative sanitation technologies at different levels of governments and in communities.

There is a need for more research on women’s use of sanitation facilities for menstrual management and the disposal of the materials.